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"ABSTRACTPurpose: To evaluate the safety and efficacy of our new delayed sternal closure (DSC) method, involving sternal semi-closure using a bioresorbable osteosynthesis device and complete skin closure.Methods: Between 2013 and 2017, 36 patients underwent DCS at our hospital. The patients were divided into two groups based on the method used for DSC. The later conventional DSC group consisted of 18 patients undergoing late complete sternal closure following fixation of pulmonary and hemodynamic instability, and the new DSC group consisted of 18 patients undergoing early sternal semi-closure a few days after surgery. In the new DSC group, the sternum was fixed with Super Fixsorb MX40, followed by complete skin closure.Results: Respiratory and hemodynamic conditions, such as systolic blood pressure, cardiac index, tidal volume, and regional oxygen saturation, were significantly more stable in the new DCS group than in the conventional DSC group. The hospital stay was also significantly shorter in the new DSC group. Although there were no serious complications, one patient from the new DCS group suffered deformity of the sternum, which was managed successfully.Conclusion: The sternal semi-closure method decreases pulmonary and cardiac instability during DSC, making early DSC possible."

"ABSTRAKLatar belakang: Beberapa komplikasi sulit yang timbul setelah tindakan sternotomi mediana yang menjadi penyebab utama mortalitas dan morbiditas pasien. Hal ini dapat dicegah dengan aproksimasi sternum yang stabil, Berbagai macam teknik jahitan fiksasi untuk aproksimasi sternum menggunakan wire. Peneliitian ini membandingkan biomekanik teknik jahitan figure of eight trans-sternal dan peristernal. Metode: Penelitian eksperimental pada sternum kambing sebanyak 36 sampel, dilakukan sternotomi mediana, kemudian dilakukan fiksasi sternum menggunakan wire, 18 sampel dilakukan fiksasi jahitan figure of eight peristernal dan 18 sampel trans-sternal. Dinilai dengan uji komparasi tiga dimensi: lateral distraction, transversal shear dan longitudianal shear dengan beban 125N, 150N, 200N, 250N, 300N, 400N. pergeseran diukur dalam mm setiap tingkat pembebanan. Dilakukan analisis statistik dengan uji independent sample t-test. Hasil: Pada uji lateral distraction dan longitudinal shear didapatkan perbedaan bermakna pada pemberian beban ringan 125N, 150N dan 200N, pada beban 300N dan 400N tidak ada perbedaan bermakna. Uji transversal shear tidak ada perbedaan bermakna pada kedua teknik jahitan. Pada hasil uji tarik kedua teknik jahitan mengalami pergeseran lebih dari 2mm pada pembebanan 250 N. Kesimpulan: Stabilitas sternum pada teknik jahitan figure of eight peristernal sama dibanding jahitan figure of eight trans-sternal.

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ABSTRACTBackgrounds There are troublesome complications following median sternotomy which are lead to major causes of morbidity and mortality of patients. This can be prevented by stable sternal approximation, Various suturing fixation method for sternal approximation using wire. To compare the biomechanics of the figure of eight trans sternal and the peristernal suturing method. Methods Experimental study on goat sternum 36 samples, performed sternotomi mediana, then performed sternum fixation using wire, 18 samples performed suturing fixation of figure of eight peristernal and 18 sample trans sternal. Assessed by a three dimensional comparative test lateral distraction, transversal shear and longitanium shear with loads of 125N, 150N, 200N, 250N, 300N, 400N. Shifts are measured in mm at each loading level. Statistical analysis was performed using independent sample t test. Results In lateral distraction and longitudinal shear tests, there were significant differences in the loading of light loads of 125N, 150N and 200N. The transverse shear test no significant difference in the two suturing techniques, In the bending test results both suturing method experience a shift of more than 2mm at 250 N loading. No other significant differrences in clinical outcomes. Conclusions The sternal stability of the peristernal figure of eight method is the same as that of the trans sternal figure of eight."

"Latar belakang: Separasi sternum atau dehisensi adalah komplikasi sternotomi mediana yang jarang terjadi tetapi memiliki angka morbiditas dan mortalitas yang tinggi. Ketidakstabilan sternum merupakan salah satu faktor timbulnya dehisensi dan teknik aproksimasi sternum adalah komponen penting dalam pencegahannya. Penelitian ini membandingkan dua teknik aproksimasi sternum menggunakan kawat baja tahan karat antara teknik trans-sternal figure-of-eight dan simple interrupted.Metode: Penelitian eksperimental secara in vivo pada 24 sternum kambing. Setelah sternotomi, 12 sternum di aproksimasi menggunakan kawat baja tahan karat dengan teknik trans-sternal figure-of-eight dan 12 sternum yang lain dengan teknik simple interrupted. Uji biomekanik yang terdiri dari regangan transversal, longitudinal dan tarikan lateral dilakukan dengan pembebanan 100- 400 N pada setiap kelompok 4 sternum . Separasi sternum diukur pada setiap pembebanan. Analisis dilakukan dengan uji T-test independent.Hasil: Pada uji biomekanik regangan transversal dan longitudinal, aproksimasi sternum menggunakan kawat baja tahan karat dengan teknik trans-sternal figure-of-eight memiliki perbedaan bermakna secara statistic dibandingkan teknik simple interrupted p 0,05.Kesimpulan: Aproksimasi sternum menggunakan kawat baja tahan karat dengan teknik trans-sternal figure-of-eight lebih stabil dibandingkan simple interrupted secara biomekanik. Kestabilan ini diharapkan dapat memberikan penyembuhan yang lebih baik pada sternum.

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Backgrounds Sternal separation or dehiscence is a rare complication of median sternotomy with high morbidity and mortality. Instability after sternotomy is one factor for the development of the dehiscence and sternal approximation technique is a key component in prevention of that. This study compares two sternal approximation technique using stainless steel between trans sternal figure of eight and simple interrupted.Methods Experimental in vivo studies using 24 goat rsquo s sternum. Sternotomy is performed. 12 sternum fixed with trans sternal figure of eight sutures using a stainless steel wire and 12 others fixed with trans sternal simple interrupted sutures. Biomechanical test consists of testing of transverse shear, longitudinal shear, and lateral distraction performed on each group 4 sternum each type of the test with a load ranging from 100 Newtons to 400 Newtons. Sternal separation was measured for each level of loading. Independent T test was performed to analize the data.Results Biomechanical test of transverse and longitudinal shear, sternal approximation using trans sternal figure of eight technique is better than simple interrupted and the difference was statistically significant p 0.05.Conclusions Sternal approximation using stainless steel wire, trans sternal figure of eight technique provides better stability rather than simple interrupted based on biomechanical analysis. This stability is expected to affect the rate of healing of the sternum better. "

"Latar Belakang: Pembuktian identitas jenazah harus secara ilmiah guna memenuhi tanggung jawab profesi dan keadilan hak asasi manusia karena diatur oleh UU Indonesia. Ada potensi tinggi dari tulang sternum untuk menjadi acuan baru identifikasi forensik. Tujuan: Mengetahui peranan tulang dada dari gambaran CT-scan populasi dewasa untuk proses identifikasi forensik di Indonesia. Metode: Penelitian potong lintang ini dilakukan terhadap 95 laki-laki dan 110 perempuan populasi Indonesia yang berusia antara 20-70 tahun dan menjalani pemeriksaan CT scan dada di Departemen Radiologi RSCM secara konsekutif. Data klinis mencakup usia, jenis kelamin, tinggi badan, dan suku sedangkan data radiologis mencakup skor osifikasi sternum dan iga, morfometrik sternum, dan variasi anatomis xiphoid. Analisis data menggunakan IBM SPSS versi 20.0 dengan uji t tidak berpasangan, korelasi Pearson, dan regresi linear maupun logistik serta kurva AUROC untuk memprediksi luaran penelitian. Semua nilai p < 0,05 dianggap bermakna. Hasil: Skor total osifikasi tulang dada berkorelasi kuat dengan usia (rs = 0,541) dengan persamaan prediksi usia secara umum = 20,417 + 4,927*LOS (osifikasi iga ujung sternal kiri) + 2,667*LOF (osifikasi iga pertama kiri) + 2,098*FX (fusi xiphisternal) (aR2 = 41,9%, SEE 9,95 tahun). Seluruh parameter morfometrik sternum berhubungan dengan jenis kelamin (p<0,05). Gabungan parameter panjang korpus, lebar sternebra 1, dan indeks sternum memiliki nilai prediksi jenis kelamin sebesar 87,3%. Terdapat korelasi panjang tulang dada dengan tinggi badan (r = 0,712) dengan persamaan tinggi badan = 97,422 + 0,466*CL (panjang sternum) (aR2 = 50,5%, SEE 5,84 cm). Tidak terdapat hubungan antara morfometrik sternum dengan daerah asal suku. Variasi anatomis sternum yang paling langka adalah ujung xiphoid trifid, terdapat suprasternal bones dan iga bifid. Kesimpulan: Sternum dapat dijadikan acuan untuk identifikasi forensik untuk penentuan usia, jenis kelamin, dan tinggi badan.

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Background: The process of personal identification must be conducted scientifically in order to fulfill the professional responsibility and human rights justice as regulated by the Indonesian Law. There is a high potential for the sternal bone to become a new reference in forensic identification.

Aim: To know the role of sternal bone from CT-scan images of adult population for the forensic identification process in Indonesia.

Method: This cross-sectional study was carried out on 95 males and 110 females of Indonesian population aged between 20-70 years who undergo a chest CT-scan in the Radiology Department of Cipto Mangunkusumo National Hospital, Jakarta consecutively. Clinical data include age, sex, stature, and tribes while radiological data include sternal and rib ossification scores, sternal mrophometrics, and xiphoid anatomical variations. Data were analysed using IBM SPSS version 20.0 with unpaired t-test, Pearson or Spearman correlation test, linear or logistic regression and AUROC to estimate age and height and also determine sex. All p values < 0.05 were considerd statistically significant.

Result: Total ossification score was positively correlated with age (rs = 0.541) with the regression formula for age estimation is 20.417 + 4.927*LOS (ribs ossification at left sternal end) + 2.667*LOF (left first rib ossification) + 2.098*FX (fusion of xiphisternal) which yielded aR2 of 41.9% and SEE 9.95 years. All sternal morphometrics parameters were related to sex determination (p < 0.05). The combination of parameters sternal body length, sternebrae 1 width, and sternal index has a correct gender prediction rate of 87.3%. There is a positive correlation between sternal length and height (r = 0.712) with the regression formula for stature estimation is 97.422 + 0.466*CL (combined sternal length) which yielded aR2 of 50.5% and SEE 5.84 cm. There is no relationship between sternal morphometrics and the origin of tribes. The rarest sternal anatomical variations are trifid xiphoid ends, suprasternal bones, dan bifid ribs.

Conclusion: The sternal bone can be used as a reference for forensic identification in estimating the age and height and also determining sex."

"For many years, observations of gingival color has been a popular area of dental research. However these methods are hard to analyze for any other than the different base conditions and colors. Thus we introduced an alternative method using image analysis to measure gingival color. For the research we performed a dental examination on 30 female students.The system is set up by aligning the camera area and facial area. The subject's chin is placed in a fixed chin cup mounted 30 cm from the camera lens. Each image is acquired such that comparisons may be made with the original bite holder as well as a standard color scale. After converted to computer we used a curves dialog box for color adjustment. The curves dialog box allows adjustment of the entire tonal range of an image.The results of the analysis of the free gingiva compared to the attached gingiva are that attached gingiva was more vivid red and yellow compared to the free gingival. In conclusion, the system described herein of digital capture and comparison of color images, analysis and separation in three channels of free and attached gingival surface images and matching with colorimetric scales may be useful for demonstrating the diversity of gingival color as well as analyses of gingival health."

"PURPOSE: A thick pancreas has proven to be a conspicuous predictor of pancreatic fistula (PF) following distal pancreatectomy (DP) using staples. Other predictors for this serious surgical complication currently remain obscure. This study sought to identify novel predictors of PF following DP. METHODS: One hundred and twenty-two patients were retrospectively assessed to determine the correlation between PF occurrence and the clinicopathological findings and radiologic data from preoperative computed tomography (CT). CT assessments included the thickness of the pancreas (TP) and pancreatic CT number (pancreatic index; PI), calculated by dividing the pancreatic CT by the splenic CT density. RESULTS: Twenty-four patients (19.7%) developed a clinically relevant PF. TP was identified as an independent risk factor for PF in multivariate analyses (odds ratio 1.17; P = 0.0095). In subgroup analyses, a lower PI in a thick pancreas was a significant predictor of PF (P = 0.032). The combination of these two prediction parameters, known as the TP-to-PI ratio (TPIR), showed a significantly better prediction ability than TP alone (area under the receiver operating characteristic curve for the incidence of PF, TPIR 0.80 vs. TP 0.69; P = 0.037). CONCLUSION: Combining the CT number with TP substantially improves the prediction ability for the incidence of PF following DP with staple use."

"Metode Triclustering merupakan pengembangan dari metode clustering dan biclustering. Tujuan dari metode triclustering adalah untuk menemukan subruang yang disebut sebagai tricluster. Metode triclustering yang akan dibahas pada penelitian ini adalah metode triclustering berbasis biclustering, yaitu THD-Tricluster dengan menggunakan new residue score dan inter temporal coherence, yang akan diimplementasikan pada data pasien yang terserang HIV-1. Metode triclustering ini terdiri atas dua tahap, yaitu generate biclusters dan generate triclusters. Selanjutnya, inter temporal coherence digunakan untuk mengevaluasi kandidat tricluster yang terbentuk pada tahap generate triclusters dan menentukan tricluster akhir yang terbentuk. Ukuran inter temporal coherence merupakan indeks yang dapat digunakan sebagai ukuran koherensi antarkedalaman dalam mengelompokkan bicluster menjadi tricluster. Pada aplikasinya, ukuran new residue score menggunakan korelasi pearson sebagai landasan untuk mencari nilai residu pada baris dan kolom bicluster. Hasil implementasi untuk tahap generate biclusters diperoleh bahwa terdapat 3 bicluster pada kondisi normal, 100 pada kondisi akut, 100 pada kondisi kronis, dan 13 pada kondisi nonprogresor. Selanjutnya, terdapat sebanyak 33 kandidat tricluster yang terbentuk pada tahap generate triclusters dengan kedalaman masing-masing tricluster adalah 4. Setelah dilakukan evaluasi skor inter temporal coherence dengan threshold ρ=0,8; didapatkan sebanyak 32 tricluster dengan kedalaman 4 dan satu tricluster dengan kedalaman 3 yang memenuhi batas skor koherensi. Keseluruhan penelitian ini dilakukan dengan pemrograman R.

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Triclustering method is the development of clustering and biclustering methods. The aim of the triclustering method is to find subspaces, called triclusters. The triclustering method that will be discussed in this study is biclustering-based triclustering method, namely THD-Tricluster using the new residue score and inter temporal coherence, which will be implemented in the data of patients affected by HIV-1. This triclustering method consists of two stages, namely generate biclusters and generate triclusters. Furthermore, inter temporal coherence is used to evaluate candidate triclusters that formed at the stage of generating triclusters and determine the final triclusters. Inter temporal coherence is an index that can be used as a measure of coherence between depths in grouping biclusters into triclusters. In its application, the new residue score measure uses Pearson correlation as the basis for finding residual values in bicluster rows and columns. The implementation results for the generate biclusters stage showed that there were 3 biclusters in normal conditions, 100 in acute conditions, 100 in chronic conditions, and 13 in non-progressor conditions. Furthermore, there were 33 candidate triclusters formed at the generate triclusters stage with the depth of each tricluster being 4. After an evaluation of inter temporal coherence score with threshold ; obtained 32 triclusters with a depth of 4 and one tricluster with a depth of 3 which met the coherence score limits. This whole research was conducted by the R programming."

"Latar Belakang. Terapi pembedahan telah menjadi baku emas dalam penutupan defek septum atrium (DSA) sekundum. Prosedur pembedahan mempunyai morbiditas yang terkait dengan torakotomi, pintasan jantung paru, komplikasi prosedur, jaringan parut bekas operasi, dan trauma psikologis. Oleh karena itu, timbul usaha pendekatan transkateter untuk menutup DSA yang bersifat relatif kurang invasif, salah satunya dengan alat Amplatzer septal occluder (ASO). Tujuan. Mengetahui perbandingan hasil penutupan DSA sekundum, komplikasi prosedur, lama rawat di rumah sakit, dan total biaya prosedur antara prosedur transkateter menggunakan ASO dengan prosedur pembedahan. Metode. Penelitian bersifat retrospektif analitik dengan sumber data berupa rekam medis pasien anak dengan DSA sekundum yang datang berobat ke Pelayanan Jantung Terpadu Rumah Sakit dr. Cipto Mangunkusumo dan dilakukan penutupan defek dengan salah satu prosedur dalam periode Januari 2005-Desember 2011. Hasil. Sebanyak 112 kasus anak dengan DSA sekundum masuk dalam penelitian, terdiri dari 70 kasus dengan prosedur pembedahan dan 42 kasus dengan prosedur transkateter. Prosedur pembedahan dan prosedur transkateter mempunyai tingkat keberhasilan yang serupa (98,6% vs 95,2%, p=0,555). Namun prosedur pembedahan mempunyai komplikasi yang lebih banyak dibandingkan prosedur transkateter (60% vs 28,6%, p=0,001, OR 1,61;95%IK,1,19-2,18). Prosedur pembedahan juga mempunyai lama rawat di rumah sakit yang lebih panjang dibandingkan prosedur transkateter (6 hari vs 2 hari, p<0,0001), dan semua prosedur pembedahan membutuhkan perawatan di ruang rawat intensif. Secara keseluruhan prosedur transkateter mempunyai total biaya prosedur yang lebih tinggi dibandingkan prosedur pembedahan (Rp.52.731.680,06 vs Rp.46.994.745,26, p<0,0001), dan biaya pengadaan alat ASO mempunyai porsi sekitar 58% dari total biaya prosedur. Analisis total biaya prosedur tanpa memperhitungkan biaya alat ASO menunjukkan prosedur transkateter mempunyai total biaya yang lebih rendah dibandingkan prosedur pembedahan. Simpulan. Prosedur transkateter dengan ASO mempunyai efektivitas yang sama dengan prosedur pembedahan dalam penutupan DSA sekundum dan mempunyai komplikasi yang lebih sedikit serta lama rawat di rumah sakit yang lebih pendek. Total biaya prosedur transkateter dengan ASO masih lebih tinggi dibandingkan prosedur pembedahan.

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Background. Surgery has become standard therapy for secundum atrial septal defect (ASD) closure, but it has significant morbidity related to sternotomy, cardiopulmonary bypass, complication, residual scar, and trauma. Non-surgical and less invasive approaches with transcatheter device were developed to occlude ASD. Amplatzer septal occluder (ASO) is one of the commonly used devices in transcatheter closure.

Objectives. This study sought to compare efficacy, complication, length of hospital stay, and total cost of secundum ASD closure procedure between transcatheter closure using ASO with surgery.

Methods. A retrospective analysis was performed on children with secundum ASD admitted to Cardiology Center of Cipto Mangunkusumo Hospital from January 2005-December 2011. The patients received transcatheter closure with ASO or surgical closure. Data were obtained from medical record.

Results. A total of 112 secundum ASD cases were included in study, consisted of 42 cases underwent transcatheter closure and 70 cases underwent surgical closure. The efficacy of both procedur were not statistically different (98.6% vs 95.2%, p=0.555). However, surgery procedure had more complication than transcatheter closure (60% vs 28.6%, p=0.001, OR 1.61;95%CI 1.19 to 2.18). Hospital stay were also significantly longer for surgery procedure than transcatheter closure (6 days vs 2 days, p<0.0001), and all surgical subjects requiring intensive care. Transcatheter closure had mean total cost Rp.52,731,680.06 as compared with Rp.46,994,745.26 for surgery procedure (p<0.0001), and cost of ASO represents 58% of the total cost of transcatheter closure. Mean total cost of transcatheter closure without including cost of device is less costly than surgery procedure.

Conclusion. Transcatheter closure using ASO had similar efficacy with surgical closure, complication rate was lower, and the length of hospital stay was shorter. However, transcatheter closure costs were higher compared with surgery procedure."